[The peculiarities of surgical treatment for regional metastatic spread of peripheral lung cancer to the other lobe].

The aim of the study was to detect peculiarities of peripheral lung cancer metastasis from one lobe to the other. The records of 26 patients were reviewed. The scheme of surgical treatment for peripheral cell lung cancer with the regard of the invasion surface area in the neighbouring lobe structures was developed. The lobectomy and resection of neighbouring lobe is recommended for patients with small peripheral lung cancer and 2 CM(2)-size invasion surface area in the neighbouring lobe structures. Wide resection of neighbouring lobe and dissection lymphatic nodes is recommended for patients with 2-4 CM(2)-size invasion surface area in the neighbouring lobe structures. A pneumonectomy is recommended for patients with more than 4 CM(2)-size invasion surface area in the neighbouring lobe structures.

[Methodological aspects of expanded operations in patients with lung cancer].

In attempt to improve the results of treatment of locally advanced lung cancer different techniques are presented and described. In 1995-2008 in Thoracal Department of Georgian National Oncological Center lung resection was performed to 2460 patients, to 1368 (55,6%) of which expanded operations were performed. There were 1070 (78,2%) male and 298(21,8%) female. Expanded operations on the right side as well as on the left side were performed in cases when metastatic lesion of mediastinal lymphatic nodes was observed. Sometimes intrasurgical biopsy of lymphatic nodes with urgent histological examination was used to verify metastases of lymphatic nodes of mediastinum. One stage removal of lymphatic nodes with lung or parts of lungs was performed. Mobilization of cellular tissues and lymphatic nodes mediastinum is described. It was accompanied by careful electrocoagulation which provides at some degree the ablasticity of interference. Expanded pneumactomies on the right and on the left sides technically had several distinctions which were defined by the anatomical peculiarities of the right and left hemithorax. For the purpose of one stage removal of paratracheal and tracheobronchial lymphatic nodes, the azygos vien was ligated in all cases of the right side expanded pneumactomy. To get the better approach to tracheobronchial lymphatic nodes in left side expanded pneumactomies, arterial duct and bronchial arteries were ligated in several cases. The removal of paraaortal lymphatic nodes on posterolateral wall of aorta in several cases, due to their site, forced us to legate some intercostals arteries in all cases, when it was possible. We tried to preserve the integrity of large nerve trunks.

[Diagnosis and results of surgical treatment of rare giant intrathoracic tumors].

Surgical treatment was performed in 19 patients aged 30 to 64 years with rare giant intrathoracic tumors. The tumor located in the mediastinum in 8 patients, in the lungs -- in 6, in the chest wall with intrathoracic growth -- in 5 patients. Diagnostic examinations included x-ray (including CT) and morphological methods. Sarcoma was diagnosed in 10 patients, mesenchymal tumors -- in 4, neurogenic tumors -- in 3, thymoma -- in 2 patients. Radical surgeries were performed in 15 patients, palliative -- in 3, explorative mini-thoracotomy -- in 1. Computed tomography and CT-assisted puncture biopsy improve the quality of preoperative diagnosis. Radical surgery is the method of choice in surgical treatment of giant benign intrathoracic tumors. Treatment policy is determined individually on the basis of the results of CT, functional and intraoperative findings.

[Diagnosis and results of surgical treatment of intrathoracic neurogenic tumors]. / Diagnostika i rezul'taty khirurgicheskogo lecheniia vnutrigrudnykh neirogennykh opukholei.

The aim of the study was to study efficiency of diagnosis and surgical treatment of intrathoracic neurogenic tumors. Since 1990 to 2002, 28 patients with neurogenic tumors underwent surgical treatment in National Cancer Center and various clinics of Tbilisi. Age of the patients ranged from 14 to 65 years. The tumors located in the mediastinum in 20 patients, in the chest wall with intrathoracic growth--6 patients, and in the lung--2 patients. Radiology (X-ray, CT), endoscopy and cytology were used for diagnosis. It was demonstrated that CT, CT-guided fine-needle biopsy and videothoracoscopy improve diagnosis of intrathoracic neurogenic tumors. Radical surgery is the method of choice in surgical treatment of intrathoracic neurogenic tumors.

[The criteria for choosing the extent of the resection of neighboring organs (structures) in lung cancer patients]. / Kriterii vybora ob''ema rezektsii sosednikh organov (struktur) u bol'nykh rakom legkogo.

Clinical and morphological criteria for the extent of resection of the adjacent organs (structures) involved in the metastatic process were defined by analyzing 598 extensive, combined, and extensive-combined operations for giant-cell carcinoma of the lung. Morphological studies of the serial sections of resected intrathoracic structures showed that the true margins of the process extent do not always correspond to those determined on revision or palpation. It was indicated that for radical intervention, the pericardium should be resected at least at 2 cm from the visible invasion edges when a tumor is extended into it. When the process is extended into the diaphragm and chest, resection should be made at least at 2 cm of the tumor edges. In endobronchial carcinoma, the bronchus should be dissected at a distance of at least 1 cm from the tumor edges, but in peribronchial and mixed forms, it should be done at least at 2 cm. Intraoperative morphological studies are demonstrated to be of high diagnostic value in identifying the local and regional extent of lung cancer.

[Results of surgical treatment of locally enlarged cancer of the lung]. / Rezul'taty khirurgicheskogo lecheniia mestno-rasprostranennogo raka legkogo.

Immediate and end results of surgical treatment of locally advanced lung cancer were studied in 197 patients. The technique of extensive, combined and extensive-combined operations is described. Postoperative complications associated with combined and extensive procedures were observed as frequently as those involved in standard surgery provided the technique was followed closely. Three-year survival rate for patients operated on for locally advanced squamous-cell cancer and adenocarcinoma of the lung was 15.2% as compared to 4.1% for those undergoing chemotherapy.

[Incidence of metastatic lesion of different groups of the intrathoracic lymph nodes in lung cancer (based on research data on surgical preparations)]. / Chastota metastaticheskogo porazheniia razlichnykh grupp vnutrigrudnykh limfaticheskikh uzlov pri rake legkogo (po dannym issledovaniia operatsionnykh preparatov).

The study was concerned with the frequency of metastatic spread of lung cancer to intrathoracic lymph nodes versus lung lobe distribution of malignancy in 299 cases of surgical treatment. In cases of primary tumor in any lobe of both lungs, metastases were detected primarily in the pulmonary and bronchopulmonary lymph nodes. A decreasing frequency of metastases was observed from the intrapulmonary lymph nodes to those of the root of the lung and mediastinum.

[The role of intra-operative biopsy in the diagnosis of regional metastases of lung cancer]. / Rol' intraoperatsionnoi biopsii v vyiavlenii regionarnykh metastazov raka legkogo.

The paper discusses the results of a histologic study of intrathoracic lymph nodes removed during surgery for lung cancer in 621 cases at different stages of metastatic spread. The gross appearance of some lymph nodes did not match their real histologic pattern: about 36% of grossly-identifiable metastatic nodes were microscopically shown to be intact whereas about 12% of grossly normal lymph nodes proved to be involved, particularly in cases of adenocarcinoma. Most of the enlarged and compact lymph nodes in cases of low-differentiated lung carcinoma revealed metastases. Intraoperative biopsy of intrathoracic lymph nodes followed by microscopy serves as a highly-predictive procedure in assessing the extent of regional dissemination of lung cancer.